The Sequelae of Tuberculous Meningitis.

The classical description of the three stages in the clinical course of tuberculous meningitis was written nearly 200 years ago by Robert Whytt, Professor of Medicine at Edinburgh University; and his conclusions that 'if this disease could be known early . . . it might sometimes be cured, but as it never discovers itself . . . till the action of the brain is disturbed . . . we have little to hope from any medicine' were valid until streptomycin was introduced by Schatz, Bugie and Waksman (1944). In February 1947, the first centre in this country for the treatment of children suffering from tuberculous meningitis was established at Alder Hey Children's Hospital, Liverpool, under the auspices of the Medical Research Council. One year later a preliminary report (Todd, 1948), based upon the response to streptomycin of 21 children with tuberculous meningitis, showed that 7 were alive, and 3 of these patients had completed streptomycin therapy and survived 19, 23 and 46 weeks after the onset of the disease. Clinically the survivors showed no evidence of meningitis, but one patient was completely deaf; a raised protein and an increased cell count were still present in the cerebrospinal fluid; psychiatric assessment showed no evidence of intellectual deterioration, change of disposition, anxiety, moroseness or apathy, but the deaf child showed some slowing of mental development not altogether accounted for by impaired hearing or a period in hospital. Such preliminary results were most encouraging, for until the discovery of streptomycin, tuberculous meningitis had been a fatal disease, most children dying within 6 weeks of the confirmation of the diagnosis. During the 15 years that have elapsed since 1947 there have been remarkable advances in the treatment of tuberculosis; in 1947, 1,080 children under 15 years of age died in England and Wales from tuberculous meningitis, but in 1961, the latest year for which national figures are available, only 18 children died from this disease. In the City of Liverpool 24 children died from tuberculous meningitis in 1947 and only 1 in 1961. Although the fall in mortality is gratifying, what are the effects upon those children who survive? Is there still the risk of deafness or some slowing down of mental development? Are the survivors physically or emotionally handicapped? Do they attend normal schools? Are they in due course able to earn a reasonable living? Our attempts to assess the physical, social, emotional and intellectual status of children who have survived an attack of tuberculous meningitis are described in this paper.